Protecting Your Information at

By Kevin Counihan

The third year of Open Enrollment is just around the corner. Starting November 1, you’ll be able to enroll or re-enroll in quality and affordable coverage at Over the last several months, we’ve been working hard to make the consumer experience even better this year – learning about what information you need to make decisions and how to improve the help and support we provide throughout the enrollment process. An important part of that is continuing to protect your privacy when you’re shopping for health coverage.

We’re committed to providing you with the opportunity to personalize your experience.  Here are a few of the updates you can expect from Today, we launched a simple way to give you more control over the information you choose to share with us – a new privacy manager. We’re also supporting the Do Not Track browser setting for our digital advertising. And, you can check out our updated privacy notice to learn more about these tools and to understand the steps we’ve taken to protect your privacy. We tried to make the policy easy to navigate while also being a lot more specific.

We know privacy is important to you when you use the web. In the process of signing up for health care coverage, you may provide us with personal information. For instance, you may enter your email address so that you can stay up to date with announcements and alerts from and learn about your affordable health coverage options.  When you sign up for health care coverage, you provide information such as your name, Social Security number, and income so that we can verify your eligibility to purchase coverage. We take protecting this type of personal information very seriously and only use it to help you get – and keep – your coverage.

Like all other websites, we receive some information automatically when you read, browse, or download information from This is information that your web browser sends when you browse the internet – such as your domain, IP address, type of device, and date and time you visited. We use this information to better understand how the site is being used – and to learn about how we can make it more helpful.

We also employ commonly used web tools like Google Analytics to analyze’s technical performance, as well as to facilitate, enhance, and measure the effectiveness of our digital advertising outreach efforts. These tools can help us do things like understand which pages on our website need improvement, to increase the speed and functionality of and make the site more useful to consumers. You can learn more about each of the third-party tools currently in use by reviewing our privacy notice.

There’s one tool, our new privacy manager, which we want to make sure you know about.  This simple tool makes it easy for you to opt-in or out of the different types of third-party tools used by – Advertising, Analytics, or Social Media. If you choose to opt-out, you’ll still have access to everything on the site, but we won’t use information from your visit to analyze the site’s technical performance or use digital advertising to remind you about helpful information like deadlines. You can check out the privacy manager now by clicking on “Privacy Settings” at the bottom of

In addition, if you have Do Not Track enabled in your browser, we’ll automatically observe your preferences related to digital advertising from

The internet is constantly changing, and we have an obligation to keep evolving alongside it. We’ll keep reevaluating our own privacy notice, the tools we use, and how they intersect with the evolving landscape of privacy on the web. We are committed to protecting the information you entrust with us at

We wish you a great shopping experience this year.

Primary care makes strides in improving quality and costs

By Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and Chief Medical Officer

Today, the Centers for Medicare & Medicaid Services (CMS) announced promising results of the first shared savings performance year for the Comprehensive Primary Care (CPC) initiative. This model is part of our broader effort at CMS to promote better care, smarter spending, and healthier people.

In 2014, CPC practices showed positive quality results, with hospital readmissions lower than national benchmarks and high performance on patient experience measures, particularly on provider communication with patients and timely access to care. CPC practices that demonstrated high quality care and reduced spending above a threshold shared in savings generated for Medicare.

During this first shared savings performance year, the initiative decreased Medicare Part A and Part B spending compared to spending targets while achieving high quality outcomes. The CPC initiative generated a total of $24 million in gross savings overall (excluding the CPC care management fees). These results reflect the work of 483 practices that served approximately 377,000 people with Medicare and more than 2.7 million patients overall. Four of the CPC initiative’s seven regions (Arkansas, Colorado, Cincinnati-Dayton region of Ohio, and Oregon) generated gross savings. The Greater Tulsa region decreased costs in excess of the CPC care management fees, generating net savings of $10.8 million and earning more than $500,000 in shared savings payments.

Quality highlights from the first shared savings performance year include:

  • Over 90 percent of CPC practices successfully met quality targets on patient experience (as determined by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys) and utilization (hospital admission and readmission) measures, indicating quality scores that matched or exceeded national comparisons.
  • All regions had lower-than-targeted hospital readmission rates. Readmissions can be burdensome to patients and caregivers and costly to the healthcare system. Lower readmissions indicate better coordination of care during transitions and patient support during the post-discharge period.
  • Patients receiving care from CPC practices scored their primary care practitioners highly, particularly on how well clinicians communicate and on getting timely access to care.

The CPC initiative launched in October 2012 to advance primary care by paying clinicians to deliver accessible, comprehensive, and coordinated care. Advanced primary care is the foundation of a high-performing health system. In addition to attending to patients’ acute, chronic, and preventive health care needs, primary care practices act as the quarterback of the health care team. CPC practices help patients navigate their care, communicate with specialists and hospitals, and ensure that patients with complex social and medical needs do not “fall through the cracks” of the health care system.

Authorized by the Affordable Care Act, the CPC initiative is a multi-payer partnership between Medicare, Medicaid, commercial payers, and primary care practices in seven regions (Arkansas, Colorado, New Jersey, Oregon, Capital District and Hudson Valley in New York, Cincinnati-Dayton region in Ohio and Kentucky, and Greater Tulsa in Oklahoma). Participating practices identify patients who are sick or at risk and provide targeted care management to improve outcomes and prevent potential adverse events. Patients at CPC practices have 24/7 access to a provider, and receive enhanced self-management and decision-making support. The CPC initiative supports these efforts by paying an additional fee for non-face-to-face care, such as tracking hospital discharges to provide follow-up support to patients.

We are encouraged by the results so far and look forward to seeing the results of our independent evaluation of these practices. Our prior experience with primary care demonstrations shows that it takes time for primary care practices to build infrastructure and improve care delivery. These CPC initiative improvements came earlier than expected in a model involving significant changes in the delivery of primary care. We look forward to supporting these innovative practices in their progress as the initiative continues.

Welcome to ICD-10

By: Sean Cavanaugh

Deputy Administrator and Director of the Center for Medicare

Today, the U.S. health care system moves to the International Classification of Diseases, 10th Revision – ICD-10. We’ve tested and retested our systems in anticipation of this day, and we’re ready to accept properly coded ICD-10 claims.

The change to ICD-10 allows you to capture more details about the health status of  your patients and sets the stage for improved patient care and public health surveillance across our country. ICD-10 will help move the nation’s health care system to better, smarter care.

You may wonder when we’ll know how the transition is going. It will take a couple of weeks before we have the full picture of ICD-10 implementation because very few health care providers file claims on the same day a medical service is given. Most providers batch their claims and submit them every few days.

Even after submission, Medicare claims take several days to be processed, and Medicare – by law – must wait two weeks before issuing payment. Medicaid claims can take up to 30 days to be submitted and processed by states. Because of these timeframes, we expect to know more about the transition to ICD-10 after completion of a full billing cycle.

Because we know this is a major transition, we’ll be:

  • Monitoring the transition in real time.
  • Watching our systems.
  • Addressing any issues that come to the ICD-10 Coordination Center.

The Coordination Center is a dedicated group of Medicare, Medicaid, billing, coding, and information technology systems experts drawn from across CMS. They have the full support of the entire CMS staff to address any issues quickly and completely.

It’s important that you know help’s available if you have problems with ICD-10:

This important moment is possible because we’ve all worked together to make it happen. We’re grateful for your support and look forward to working with you as we make this transition.


Helping You Help Your Employees with Medicare Enrollment

September 25, 2015

By Sean Cavanaugh, Deputy Administrator and Director, Center for Medicare

Do you have employees or retirees who are eligible to enroll in Medicare?  Many people are still working when they’re first eligible for Medicare, and they need to decide if they should get Medicare Part B coverage.

Those newly eligible for Medicare who are still working or have employer coverage have important decisions to make.  It’s important they understand how and when to enroll, as well as the consequences of not enrolling.  Those who don’t enroll timely may have gaps in their insurance coverage and may pay more for Part B (late enrollment penalty) for as long as they have that coverage.  There’s other important information to understand about Medicare enrollment, for example:

  • Some people get Medicare automatically, and some need to sign up for it.
  • People can enroll in Medicare Part B only at certain times.
  • There are special enrollment rules for those who are still working and covered by an employer.
  • Not everyone with Medicare is 65 or older.

CMS has a new web resource to help you help your Medicare-eligible employees understand Medicare and other retirement issues they may face.  This one-stop shop is ( where you can easily connect with information about many topics including:

We encourage you to check out this new page to get the up-to-date, official information about Medicare enrollment and other retirement topics to share with your employees and retirees.

ICD-10: One Week Out

By Dr. Bill Rogers, ICD-10 Ombudsman

In one week, the U.S. health care system will start using the International Classification of Diseases, 10th Revision. This is a huge moment because ICD-10 will help doctors and other health care providers better:

  • Define patients’ clinical status and treat their complex medical conditions.
  • Coordinate care among providers.
  • Support new payment methods that drive quality of care.

As we come to October 1st, CMS wants to assure the medical community that we’ve tested and retested our systems, and we’re prepared to solve problems that may come up.

Because we know this is a major transition, we’ll be:

  • Monitoring the transition in real time.
  • Watching our systems.
  • Addressing any issues that come to the ICD-10 Coordination Center.

We’ll also be supporting you in four ways:

  1. If you need general ICD-10 information, we have many free resources at our Road to 10 webpage and on gov/ICD10 that can help, such as the ICD-10 quick start guide, customized ICD-10 action plans, videos, and Frequently Asked Questions.
  1. Your first line for help for Medicare claims questions is to contact your Medicare Administrative Contractor. They’ll offer their regular customer service support and respond quickly. You can find MAC contact information here.
  1. You can e-mail our ICD-10 Coordination Center, and we’ll respond to your questions.
  1. You can contact me, the ICD-10 Ombudsman. I’ll be an impartial advocate for providers, focused on understanding and resolving your concerns.

We’ve been working to help you move to ICD-10 by offering resources and flexibility, but if you aren’t ready for the transition, you still have options that will enable you to continue to provide care and be paid for your services. We recommend that you check with other payers to learn about their available claims submission alternatives.

The Road to 10 countdown clock highlights how close we are to this important milestone. If you haven’t yet started to transition, it is doable, and we encourage you to start today.

New Value-Based Insurance Design Model Aims to Make Medicare Advantage Even Better

By Patrick Conway, M.D., MSc, CMS deputy administrator and chief medical officer

As part of its ongoing work to identify more effective ways to serve Medicare beneficiaries, the Center for Medicare and Medicaid Innovation in the Centers for Medicare & Medicaid Services (CMS) announced today the Medicare Advantage Value-Based Insurance Design Model, which will test whether providing flexibility to Medicare Advantage plans (including Medicare Advantage-Part D plans) to reduce cost sharing or offer extra benefits available to enrollees with certain conditions will improve the quality of enrollees’ care while also reducing overall costs. Reduced cost sharing or extra benefits are increasingly available in some employer-sponsored plans to enrollees with special health needs, to encourage them to make better and increased use of high-value items and services – those that have the greatest potential to positively impact their health. Medicare Advantage plans generally have not used these “Value-Based Insurance Design” (VBID) approaches because of existing regulations that require uniformity in plan premiums, benefits, and cost-sharing responsibilities for plan enrollees. Under this model, however, CMS will give Medicare Advantage plans that meet selection criteria in a set of states the flexibility to offer VBID benefits – such as extra coverage or reduced cost sharing for high value services – to enrollees with CMS-specified chronic conditions. This new flexibility could support Medicare Advantage plans in helping enrollees improve their health, and subsequently reduce the use of avoidable high-cost care, while reducing costs for plans, beneficiaries, and the Medicare program. The model test will begin January 1, 2017 and run for five years in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee. Eligible plans in these states can have varied plan benefit design for enrollees who fall into certain clinical categories defined by CMS: diabetes, congestive heart failure, chronic obstructive pulmonary disease (COPD), past stroke, hypertension, coronary artery disease, mood disorders, and combinations of these categories. Plans have the flexibility to choose amongst the eligible categories, and design separate interventions for each one. Changes to benefit design made through this model may only reduce cost sharing for services, and/or offer additional services; enrollees will never receive fewer benefits or have to pay higher cost sharing as a result of the model. The Medicare Advantage Value-Based Insurance Design Model fills an immediate need for testing ways to improve care and reduce cost in Medicare Advantage Plans, offering the prospect of lower out-of-pocket costs and premiums for Medicare Advantage enrollees.

New Options for Simple, Quick Enrollment in Medicaid and CHIP

By Vikki Wachino

Medicaid continues to make advances in covering and enrolling eligible low-income people in health insurance coverage.  Our latest data, released today, show that as of June, enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) grew by almost 13.1 million people since just before the first Marketplace open enrollment period in 2013.  And Medicaid and CHIP enrollment increased by more than 292,000 individuals since May. Simplified policies and systems advances that promote timely enrollment of eligible people in coverage underpin this progress.  Today, CMS is taking the next step in those efforts by making new opportunities available for states to help enroll people in Medicaid and CHIP quickly and easily.  Under new guidance released today, we are offering states an opportunity to use Supplemental Nutrition Assistance Program (SNAP) data to support Medicaid eligibility determinations for some people who are certain to be Medicaid eligible at both initial application and renewal.  Under new guidance released today (, we are offering states a new state plan option to use gross income established in Supplemental Nutrition Assistance Program (SNAP) to support Medicaid eligibility determinations for some people who are certain to be Medicaid-eligible at both initial application and renewal.  The new guidance also clarifies and extends the time frame that applies in states that are using or wish to take up targeted enrollment strategies under the waiver authority we established in 2013. The new state plan option builds on targeted enrollment strategies CMS established under waiver authority in 2013 for states to enroll or renew eligibility without requiring individuals to complete a new application or renewal form.  Those strategies, which six states have used to enroll more than 725,000 people, have been used to successfully and efficiently enroll individuals newly eligible for Medicaid coverage and helped states promote rapid enrollment, manage high application volumes, and manage systems constraints.  Tomorrow, as Alaska becomes the 30th state (including DC) to implement Medicaid expansion, it will use some of those strategies to help low-income adults enroll quickly so that they can get needed care. By connecting newly enrolled adults with health care, Medicaid is helping them identify and address health needs and promote their health and well-being. We have been pleased to work with our partners at USDA’s Food and Nutrition Service in strengthening the connection between SNAP and Medicaid so that more low-income families and individuals will have both the nutritional support and the health care they need to build financial security and health.  We welcome additional ideas as we continue to work with states on expanding Medicaid and on simplifying and streamlining enrollment of eligible people in Medicaid and CHIP.  


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